Fecal Transplants Effective Against Persistent and Deadly Infection

June 4, 2013

By Steve Frandzel

Think of fecal transplantation as the ultimate probiotic treatment minus the marketing hype. Fecal transplants are growing in popularity as a treatment for patients infected with the highly virulent bacteria Clostridium difficile (C. difficile), and Emory is among the growing number of medical centers where it’s happening.

The risk of contracting the disease increases significantly following antibiotic use, because the drugs kill some of the normal, helpful bacteria in the gut while allowing the toxic bacteria to flourish. Ironically, the standard treatment for C. difficile is treatment with other antibiotics. Without enough helpful bacteria in the gastrointestinal track, C. difficile can grow out of control and produce toxins that attack the intestinal lining. C. difficile symptoms range from diarrhea to life-threatening inflammation of the colon.

According to the Centers for Disease Control and Prevention, C. difficile infections strike more than 336,000 people in the United States annually and are linked to 14,000 deaths. The number of people contracting the hard-to-manage disease is on the rise.

“The microorganisms that inhabit the human digestive system are devastated by antibiotics,” said Colleen Kraft, MD, Assistant Professor in Department of Pathology and the Division of Infectious Diseases, and Medical Director of the Emory Healthcare’s clinical microbiology laboratory. Kraft initiated and established the fecal transplant program at Emory in July 2012.

Twelve patients have so far undergone the procedure at Emory Healthcare. Three patients needed a repeat transplant, but all are doing well.

The procedure involves taking a small amount of fecal sample (about 4 oz.) from a suitable donor – a person who is not taking chronic medications, has not used antibiotics for many years, and who does not have school-aged children, who frequently succumb to gastrointestinal afflictions. Donors do not have to be family members. The sample is processed in a lab, then introduced into the patient’s large intestine via a colonoscope, or into the stomach through a tube that runs through the nose and down the esophagus. When everything goes as planned, the microorganisms in the donated fecal matter kick start the repopulation the diminished microbiota in the patient’s gut.

“I think it’s miraculous that we can give such a small amount and achieve such a high level of clinical success,” Kraft said. “I don’t want to overstate [the effect], but I think it’s going to be life saving.”

Fecal transplantation is nothing new, but it’s certainly making a resurgence. The first reports are thought to come from Chinese medicine centuries ago, according to Kraft, and a report from the medical literature dates to 1958.

The FDA this month began regulating the procedure, so Emory’s program is on hold until it receives the agency’s go ahead. Kraft expects to restart the program within the next few months. She has received a University Research Committee Grant to study the microbiota related to this procedure. “Our goal is to figure out what part of the treatment is the curative aspect.”